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Biomedical subjects

J E Meyer

Publications and source records attributed to J E Meyer.

At least 19 recordsLinked to original sources

Image-guided aspiration of solitary occult breast 'cysts'.

During the 30-month period from March 1, 1988, through August 31, 1990, image-guided aspirations of 183 solitary occult breast masses, which were considered possible cysts, were performed. Indications for aspiration included (1) mass on mammography, either invisible on ultrasonography or with features atypical of a cyst, in 111 patients; (2) enlarging solitary mass on mammography with ultrasonic features suggesting a cyst in 45 patients; and (3) mammographic mass with features typical of a cyst in 27 patients, with confirmation requested by the referring physician. Of the group, 151 (83%) lesions were fluid-filled and 32 (17%) were solid. All aspirates had normal cytologic features. Of the 32 aspirates found to be solid, 19 were subsequently removed after wire localization and 13 were unchanged on mammography for a minimum of 6 months after aspiration. This is a simple and safe procedure, confirming the innocuous nature of an occult solitary breast cyst, and obviates the need for surgical biopsy.

Adult

[The new euthanasia-discussion from the psychiatric viewpoint].

The practice to kill terminally ill patients on their own demand has resulted in the Netherlands in a decriminalisation of active euthanasia which thus has fundamentally changed the way to deal with dying patients. Sooner or later this development will extend to other European countries as well as to the USA. Involuntary euthanasia of severely handicapped newborn children or of demented persons is propagated by the practical ethics of P. Singer and other representatives of utilitarianistic philosophy. According to the standpoint of utilitarianism a human being should only have the right to live as long as he or she is a person, i. e. has rationality and self-consciousness. The next step toward the elimination of elderly people can easily be predicted. For economical reasons these persons may be withheld from life-saving medical treatment or may be supposed to commit suicide. A moral pressure is created to make a decision for suicide as soon as severe invalidity occurs. The consideration of such ideas shows that in today's debate on euthanasia the issue is no longer the right of a few severely and terminally ill human beings to their "own death". Instead, the right to live of a large group of handicapped and "socially useless" or "unproductive" persons is at stake. This is the danger of today's discussion of euthanasia.

Persons with Disabilities

Improved radiology film library operations.

An interdisciplinary task force at the authors' institution developed a design for a new film library that placed heavy emphasis on service to its customers. The task force established locations and staffing for "satellite" inpatient film libraries organized by clinical specialties. Inpatient films were not permitted to be taken from the radiology department but were available for 24-hour viewing. Film locations were recorded in the radiology information system. Reorganization led to important improvements in film library operations and in the clinical staff's opinion of film library service. Objective measures of performance, such as the fraction of requested films available for conferences, showed significant improvement (P less than .001). Closer working relationships developed between film librarians, radiologists, and their clinical colleagues. Film library personnel were recruited more easily and stayed on the job longer. Several hundred thousand film-tracking transactions per year were recorded. The authors conclude that decentralization of certain film library activities improved many critical aspects of performance.

Libraries

Fibrosarcoma of breast metastatic to stomach.

A case of fibrosarcoma of the breast metastatic to the stomach and small bowel is reported. Upper gastrointestinal bleeding secondary to a "bull's eye" or "target" gastric ulcer was successfully treated by surgical resection.

Breast Neoplasms

Giant ureteral calculi.

Giant ureteral calculi are defined as weighing at least 50 g or measuring more than 5 cm in greatest diameter. Two patients with this rare entity are described.

Female

Fat necrosis of the breast.

Fat necrosis of the breast is an uncommon entity but may mimic malignancy on both mammographic and clinical examination. Seven patients had recent excisional breast biopsy specimens that showed fat necrosis. The mammographic appearance is a reflection of the reparative phase of the lesion, with a cystic appearance representing early or incomplete healing. Progression to connective tissue invasion appears as an irregular, dense, spiculated mass. Clinically, these tumors may be firm, fixed, and produce overlying skin or nipple retraction. No matter how strong the clinical suspicion that a breast lesion represents fat necrosis, an excisional biopsy is necessary for confirmation in all cases.

Adult

Pretreatment radiographic evaluation of patients with malignant melanoma.

During a four year period, 53 patients with malignant melanoma underwent extensive pretreatment radiographic evaluation for detection of occult extranodal metastatic disease. This included chest x-ray with tomography, upper G.I. series with small bowel follow through, barium enama, intravenous pyelogram, and radio-nuclide scans of the brain, liver and bone. All occult metastatic disease in asymptomatic patients was discovered on routine chest x-ray examination. There were three false positive examinations, which necessitated further diagnostic tests but there was no change in the final treatment decision. There was no alteration in the management of the remainder of the patients on the basis of the pretreatment radiographic evaluation.

False Positive Reactions

Radiographic evaluation of metastatic melanoma.

Malignant melanoma can potentially involve any organ system in the body once it metastasizes beyond the regional lymph nodes. A survey of the radiographic and associated clinical manifestations of metastatic melanoma is presented. The findings from 74 autopsies of patients who died of metastatic melanoma are included.

Adult

Thoracic effects of therapeutic irradiation for breast carcinoma.

Therapeutic irradiation produces alterations in normal tissue which, when visible on diagnostic x-ray examinations, may be confused with recurrent tumor or other unrelated conditions. Therapeutic irradiation of breast carcinoma may produce gross effects in the lungs, bone, breast, heart and great vessels, esophagus, liver, and spinal cord. The radiographic appearance of such changes is presented and contrasted with changes secondary to the malignancy itself or benign inflammatory processes. Recognition is imperative for proper management.

Aged

A twelve month comparison of penfluridol and trifluoperazine in chronic schizophrenic outpatients.

This investigation is a 52-week double-blind study comparing the efficacy and safety of penfluridol and trifluoperazine in 25 chronic schizophrenic outpatients. Penfluridol was administered once weekly and trifluoperazine daily. Measurements were made at baseline, various fixed intervals during the study period and termination. The data reveals that both agents were similarly effective in maintaining control of the symptoms of chronic schizophrenic patients at a level commensurate with or better than that provided by their previous medication. Besides being effective, medications were also well tolerated. The side effects were characteristic of marketed neuroleptics. Akathisia was more common with penfluridol but readily controlled with anti-parkinsonian medication. Other side effects were similar in severity and occurrence between study-drug groups. Both agents had low autonomic liability, and neither agent was depressogenic.

Adult

Extradural metastatic breast carcinoma detected on a bone scan.

A patient with an untreated breast carcinoma and a clinically minimally symptomatic, extradural spinal cord compression secondary to metastatic disease is described. The observation of an abnormally distended urinary bladder on a bone scan led to the prompt diagnosis and successful treatment of a total spinal cord block.

Bone and Bones

Percutaneous aspiration biopsy of nodular lung lesions.

Over a 24 month period, 39 patients with nodular lung leasions suspected of being malignant on chest x-ray study underwent transthoracic needle aspiration biopsy. An accuracy rate of nearly 100 per cent was obtained in 34 of the lesions subsequently proved to be malignant. Achieving these results requires very close cooperation between the departments of radiology, cardiology, and cytopathology.

Biopsy, Needle